Eating – help yourself during cancer treatment

These can be used to add energy and protein to food, for example:

• use full fat dairy produce, such as full cream milk and full fat yogurt in place of low-fat varieties (yogurt may be labelled ‘luxury’ or ‘thick and creamy’ rather than ‘light’, ‘diet’ or ‘low fat’). Avoid bio/probiotic yogurts if you are undergoing chemotherapy or are neutropenic.
• if you prefer, use non-dairy milk alternatives such as soya, almond, rice or oat milks. Choose full fat varieties and ones that are fortified with vitamins and minerals –replace cups of tea and glasses of water with milky drinks such as hot chocolate, malted milk and milky coffee – also lattes, cappuccinos and flat whites. Try drinking these between meals and at suppertime.
• add milk powder or Complan Original to soups, sauces, milky puddings and custard
• keep a box of grated cheese ready in the fridge and add to sauces, sprinkle onto soup or pasta, add extra to pizza, use to fill sandwiches, have with crackers and butter or mix into mashed potatoes
• add extra paneer, cream or full fat yogurt to curries
• use full cream milk or evaporated milk to make milk jellies, Angel Delight and instant whips –serve cream, yogurt, fromage frais or evaporated milk with cereals, puddings and pies or add to soups, sauces and desserts
• make fortified milk by mixing 4 tablespoons of milk powder with 1 pint of whole, full fat milk and use whenever you would use ordinary milk, to increase the protein content

These can be used to add extra energy to food, for example:

• put plenty of butter, margarine or nut butter on bread, toast, scones, crumpets, malt loaf, teacakes, crackers, jacket potatoes, mashed potatoes and vegetables
• use mayonnaise, cream cheese, sour cream, salad cream, hummus and oil-based salad dressings in sandwiches, in salads, on jacket potatoes, on bread or use as a dip
• be generous with the amount of ghee, olive oil, butter or margarine that you use in cooking
• stir cream, full cream yogurt, mascarpone cheese or crème fraîche into soups, sauces, casseroles, cereals or milk puddings
• spread large amounts of chocolate spread, peanut butter or lemon cheese on bread, toast, crackers, oat cakes, crumpets, pancakes or pitta bread
• snack on nuts, seeds and chocolate –add nuts or seeds to cereal or soups
• if you want to reduce the amount of saturated fats while still keeping your calories high, you can swap butter for oil or oil-based spreads (such as olive oil or vegetable based)

These can also be used to add extra energy to food, examples of sugars include:

• white or brown sugar
• honey, syrup, molasses or treacle
• jam, marmalade and lemon curd

These can be added to drinks, stirred into puddings or sprinkled over cereals.

• crisps
• nuts – peanuts, cashews, pistachios, brazil, walnuts etc .
• tortilla chips or nachos – try eating with guacamole, salsa or sour cream
• prawn crackers
• small sandwiches or rolls – remove the crusts and have with a filling such as egg mayonnaise, tuna mayonnaise, cream cheese or peanut butter
• cheese – grated or cubed, also cheese slices, cream cheese and cheese triangles – eaten with crackers, oatcakes or maybe with some toast
• sausage rolls, cocktail sausages, pasties or pork pies, scotch eggs, boiled eggs
• spring rolls or sesame toast – try dipping into sweet chilli sauce
• samosas, pakoras or onion bhajis
• poppadoms with chutney
• tamarind balls
• satay
• falafel
• hummus or taramasalata with pitta bread or breadsticks/vegetable sticks
• feta cheese and olives
• chips and mayonnaise, vinegar or tomato sauce
• toast, crumpets, pikelets crackers, savoury biscuits
• avocado on toast

• dried fruit mixtures, for example raisins, cranberries, apricots, dates, figs, sultanas
• chocolate biscuits or mini chocolate bars
• cereal bars, flapjacks, nut bars, oat bars, granola
• cereal and milk
• popcorn
• cakes, biscuits and sweets
• croissants, currant teacakes, hot cross buns or malt loaf
• fruit loaf with a spread or butter

• porridge or instant oat cereal made using full cream milk. Try adding in some cream, also some sugar, honey, syrup or dried fruit to sweeten it
• cereal or muesli with full cream milk and sugar, or full fat yogurt – try topped with a sliced banana/dried fruit
• full-fat Greek or soya yogurt with fruits such as banana, strawberries, raspberries or blueberries – or stewed fruits such as apples, rhubarb or apricots
• croissants, pain-au-chocolat, pancakes
• buttered toast or bagels with jam, peanut butter or chocolate spread
• scrambled, poached or boiled eggs, also omelette, fried eggs or French toast (bread dipped in beaten egg and fried)
• smoothies – made by blending fruits together with milk and yogurt
• cheese or baked beans on toast
• cooked breakfast

• omelettes or frittatas filled with cheese, ham or mushrooms
• well-cooked eggs – scrambled, poached, boiled or fried – try having with fingers of buttered toast
• beans or tinned spaghetti on buttered toast topped with grated cheese
• sardines or pilchards on buttered toast
• soup made with beans or lentils served with croutons and a buttered roll
• casseroles, stews or hotpots made using meat or beans and topped maybe with a dumpling
• cottage pie, shepherd’s pie, spaghetti Bolognese, chilli con carne, lasagne or moussaka – these can also be made using soya mince or Quorn. Try topping with extra grated cheese to make even more nourishing
• fish poached, grilled or fried, also fish fingers, fish in batter, fish cakes and fisherman’s pie – serve with chips or bread and butter
• cauliflower cheese or macaroni cheese
• korma, tikka masala, channa curry or dahl served with rice, naan bread or chapatti – even tastier if served with brinjal pickle or mango chutney
• Thai curry served with basmati or sticky rice
• meat, fish, tofu or Quorn – stir-fried and served with noodles or rice and maybe a stir-fry sauce
• sausages (meat or vegetarian) with mashed potato and onion gravy
• quiches, flans or pies
• pizza topped with extra cheese
• toasted sandwiches or cheese on toast
• jacket potatoes – try mashing the flesh of the potato with butter and cream and extra cheese

• milky puddings such as custard, rice pudding and semolina, also Angel Delight, instant whips and milk jelly
• egg custard
• desserts such as yogurt, fromage frais, crème caramel, mousse, cheesecake, soya desserts and trifles. Buying these in small, individual sized pots from a supermarket is often easier and less wasteful
• ice-cream, sorbet or frozen yogurt
• fruit, tinned or fresh e.g. bananas and peaches – try serving with cream, ice cream, evaporated milk, kulfi or custard
• meringues, vanilla slices, fruit tarts and slices of cake
• sponge pudding, sticky toffee pudding or bread and butter pudding all of which are easier to eat if topped with custard, cream or ice cream

These may be easier to manage than solid food.

• hot milky drinks, for example, Horlicks, Ovaltine, hot chocolate, cocoa and milky coffees such as latte, cappuccino, flat white etc.
• cold milkshakes with added ice-cream
• fruit juices or vegetable juices
• cup-a-soups or packet soups – make these up using milk rather than water
• smoothies made with milk or yogurt
• alternative milks (e.g. soya, rice, oat, almond or coconut) – make sure they are calcium-enriched
• lassi
• special powdered drinks such as: Complan (Nutricia), Meritene (Nestlé) or Recovery (Boots) – these can replace a light meal. They are best made with milk and come in a range of sweet and savoury (soup) flavours. They can be bought at most chemists or supermarkets. Try a variety to find the ones you enjoy the most

Some special meal replacement drinks are available on prescription. Ask your doctor or dietitian whether they are appropriate for you.

Radiotherapy or chemotherapy can make your mouth dry or sore. If it becomes difficult to eat, you may find it helpful to:

• take plenty of fluids – we suggest at least 10-12 glasses/mugs a day
• keep your mouth fresh and clean – ask the nursing staff for advice about mouth care eat easier to chew foods
• add gravies, sauces, butter or mayonnaise to food to make it more moist
• drink through a straw
• include nourishing drinks

If your mouth is dry

• sip drinks frequently, especially with meals
• suck ice cubes or lollies – try making them with lemonade for a change
• fizzy drinks can make your mouth feel fresher
• suck strongly flavoured pastilles or mints or chew sugar-free chewing gum to keep your mouth moist
• sharp flavours such as lemon or lime may help your mouth produce more saliva, but don’t use them if your mouth is sore
• avoid dry foods such as bread, potatoes, crackers, cold meats, hard boiled eggs and chocolate
• pineapple slices can be refreshing
• artificial saliva or pastilles are available – ask your doctor or nurse about this

If your mouth is sore

Avoid the following as these may hurt or irritate:

• salty or spicy foods
• acid fruits and juices such as oranges, grapefruit, lemon, lime, tomato and also vinegar
• chewy, coarse or dry foods such as tough meat, crisps, toast, hard cereals and dry biscuits
• alcohol
• food that is very hot or very cold
• foods that stick to your mouth such as chocolate, nut butter or pastry

One of the side-effects of your illness or treatment is that your sense of taste may be affected so that food either loses its flavour or just tastes different. This situation can last for several months making it difficult to find things to eat and drink that you enjoy.

Don’t forget that your body still needs many nutrients to help it recover from treatment and minimise weight loss.

• Keep your mouth fresh and clean with good mouth care and by drinking plenty of fluids. Ask nursing staff for advice about this, especially if your mouth feels coated.
• If tea or coffee taste unpleasant, consider replacing these with fruit squash or hot Bovril, Oxo or Marmite.
• Sharp-flavoured or fizzy drinks and fruits may stimulate your taste buds.
• Use herbs, spices, tomato sauce, brown sauce, chutney etc. to add flavour, though be careful not to use too many spices if your mouth is sore.
• Try sucking mints or fruit sweets or chewing on sugar-free gum.
• If food tastes bland, try putting different temperature foods together, such as fruit crumble and ice cream, or different textured foods together such as cottage pie and crunchy vegetables, or yogurt and crushed nuts.
• You may find you enjoy savoury foods more than sweet ones. If red meat tastes unpleasant, see if blander foods such as fish, chicken or turkey and eggs or dairy produce such as milk, cheese or yogurt, taste better. Pulses such as peas, beans and lentils can also be very useful.
• Soaking or marinating meat in fruit juice or wine before cooking may improve the flavour, as can having salty foods such as crisps, bacon, ham and crackers.
• If, however, you dislike the taste of savoury foods then try eating more sweet ones instead.
• Present food nicely so that you can still enjoy how it looks as well as how it smells. Concentrate on foods you enjoy even if they are different from your usual favourites, but don’t eat foods if you find they taste unpleasant.
• Sipping drinks through a straw can avoid some of the taste buds and may cut down unpleasant tastes.
• If you have a metallic taste in your mouth, try sucking on mints, chewing on sugar-free gum, eating salty food or using plastic knives and forks to help overcome it.

Radiotherapy near your mouth or throat and some types of chemotherapy can make your throat sore, so that it is hard to swallow.

With some types of illness or treatment you may experience a sore mouth or swallowing problems. This can be due to pain, inflammation, oral thrush or due to the position of the tumour, e.g. oesophageal cancer. In this case you may find that foods that are ‘easy to chew’ are more comfortable and manageable.

Sometimes the timing and co-ordination of the swallow may be affected. If you experience any of the following symptoms, then you may have a swallowing difficulty:

• coughing on swallowing diet or fluids
• difficulty breathing after eating/drinking
• wet or gurgly voice after eating/drinking
• pocketing food in mouth
• unexplained chest infections

You must inform a member of your medical team if you experience these, as you may require a referral to the speech and language therapists to assess the safety of your swallow. They will advise you on the safest texture of diet and fluids.

It is quite common to feel full even after small amounts of food and this can be very uncomfortable:

• graze on small frequent snacks and drinks rather than eating large meals
• take liquids between meals rather than just before, or whilst eating food, as they can fill you up
• be aware that rich or fatty foods can be more difficult to digest and can therefore leave you feeling full for longer
• you may find cold food and drinks, (e.g. yogurts, ice cream, fruit fool, and iced drinks) can be easier to manage
• try to relax when you are eating, eat slowly and chew foods well
• consider taking a little gentle exercise – such as a short walk after meals, as it can be helpful
• wind can make you feel very full and bloated. Try avoiding things such as fizzy drinks, cabbage, cucumber, onions and pickles or any other items that you know makes symptoms worse. Sugar-free mints or chewing gum may cause wind
• some people find peppermint cordial, peppermint tea or mints helpful for clearing trapped wind

Nausea or sickness can be due to your disease, treatment or medication. If you are experiencing this, talk to your doctor or specialist nurse. They may be able to prescribe anti-sickness medication to help.

Additionally, if you are feeling sick:

• try salty foods such as crisps, crackers or savoury biscuits; dry foods such as toast, plain cake, plain biscuits (Rich Tea, gingernut, arrowroot etc.) or bland foods such as chicken and eggs
• avoid foods if they make you feel worse. Examples may include greasy or fried foods, spicy foods or foods with a strong smell
• eat and drink slowly
• avoid the smell of food or cooking – cold foods usually smell less than cooked ones
• drinks sipped through a straw often taste better
• try sucking mints or boiled sweets
• asking someone else to prepare food for you may also help
• sometimes ginger – taken as ginger ale, gingernut biscuits, crystallised ginger or lemon and ginger fruit tea – can be soothing and helpful
• try a little light exercise or fresh air before eating
• sit up to eat and don’t lie down immediately afterwards
• avoid going long periods without food. You may find that nibbling frequently on snacks or light meals helps keep the sickness under control

If you are being sick:

• Let your doctor or specialist nurse know as they may be able to prescribe some medication to help.
• It is important that you keep drinking plenty of fluids. Try cold, clear fluids such as squash or fruit juice, and aim for a minimum of 10 to 12 drinks each day to ensure you are replacing any fluids that are being lost.
• You may find it easier to sip drinks through a straw.
• Slightly fizzy drinks may also be helpful.
• As the sickness settles, start to include nourishing milky drinks.
• Gradually move on to light meals and snacks.

Diarrhoea can be due to your treatment, medication, illness or infection. If you are experiencing this, please discuss it with your doctor or specialist nurse to identify the cause and to see if you require any medication.

It is important to drink plenty of fluids to replace any lost fluids and to avoid becoming dehydrated. Check for signs of dehydration (passing less urine, or small amounts of dark urine). If this persists, please speak to your doctor. As a guide, aim for a minimum of 10 to 12 drinks (2 litres) per day.

Fluids can be:

• Water
• coffee, tea, herbal tea, fruit tea
• squash, cordial, diluted fruit juice
• Bovril, clear soups, Oxo
• milk, milky drinks, milkshakes. Some people may find that milk makes their diarrhoea worse due to the lactose content. You can choose lactose-free milk or milk alternatives (soya, rice, nut milks) instead

Tips

• Try to eat little and often.
• Chew your food slowly.
• Some foods may make it worse – caffeine, alcohol, spicy foods, greasy or fried foods, nuts and seeds.

There is little evidence for reducing the fibre content in your diet. Try to continue eating your normal diet.

Constipation may be as a result of disease, treatment or medications. Some painkillers can be especially constipating.

At this time, drink plenty of fluids – aiming for at least 10 to 12 glasses or mugs daily. Try taking some gentle exercise such as walking.

For some people it is advisable to increase the fibre content of their diet, for others they may need to decrease it, if it is not diet related. Please speak with your doctor for advice on what is appropriate for you and if you require laxatives.

If you have been advised to follow a low-fibre diet, then refer to The Christie booklet ‘Eating well when following a low fibre diet’ for advice on what to eat.

If you are eating well and eating a variety of foods, you are unlikely to need a vitamin and mineral supplement. If your appetite is poor, you may need a standard complete multivitamin preparation to meet your daily needs.

Examples include Centrum, Boots A-Z multi, Sanatogen A-Z Complete and Nature’s Best A-Z multi. Please be aware that high doses of vitamins and minerals can be harmful and may interfere with your medication and your treatment. Speak to your doctor, dietitian or pharmacist if you have further queries regarding this.

There are several alternative diets claiming to treat or cure cancer. Some diets recommend avoiding certain foods or taking large doses of vitamins or minerals. There is no scientific evidence that these diets can make cancers shrink, cure the disease or reduce recurrence.

The effects of such diets on your general health are not known as these diets have not been properly researched. If you are thinking of following a special diet, please discuss this with your dietitian, consultant or specialist nurse.

If your appetite is poor, it may be appropriate to relax your diabetic or cholesterol-lowering diet and include some foods and drinks that you may not normally eat. Ask your dietitian or doctor for advice. Please ask for a copy of The Christie 22 booklet ‘Eating well with diabetes when you have a poor appetite’.

If you are eating well, eating a variety of foods, and have no weight loss then continue to eat your normal healthy diet. If however, you are about to start treatment, your appetite could be affected.

It is important to keep your body nourished and prevent any weight loss, so follow the guidelines in this booklet, should it become appropriate. Once you have completed and recovered from your cancer treatment, you may wish to refer to the information booklet ‘Eating well following treatment and recovery from cancer’ for advice on healthy eating.

Keep yourself safe and healthy by taking extra precautions with your food preparations. Make sure the area is clean and wash your hands before and after food preparation using soapy water. Avoid unpasteurised dairy and raw or under cooked meat, poultry, eggs and seafood.

It is recommended not to have these whilst you are having chemotherapy or if you are neutropenic. For further advice on eating and chemotherapy, see The Christie booklet ‘Chemotherapy’.

If you are a haematology/transplant patient, please follow the advice on diet in The Christie booklet ‘Welcome to Palatine ward’.